(Twins; Triplets; Quadruplets; or More)
A multiple pregnancy is when a woman is pregnant with two or more fetuses. Twins are the most common type of multiple pregnancy. So-called “higher-order” pregnancies (when a woman is carrying triplets, quadruplets, quintuplets, or more) are less common.
The risk for certain complications during and after pregnancy is higher in multiple pregnancies. To lessen these risks your doctor will see you more often than a woman carrying one baby.
Twins in Utero
Multiple pregnancies occur when a single fertilized egg divides and develops into two or more fetuses (identical twins) or when more than one egg is fertilized by a different sperm (fraternal twins). Triplets, quadruplets, and quintuplets can be identical, fraternal, or a combination of both.
Triplets in Utero
A risk factor is something that increases your chances of getting a disease or condition. The following factors increase your chance of having a multiple pregnancy. If you have any of these risk factors, tell your doctor:
- Use of fertility treatments
- A previous multiple pregnancy
- A family history of multiple births
- More than one previous pregnancy
- African-American race
- Older age
If you experience any of these symptoms do not assume it is due to a multiple pregnancy. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
Symptoms include the following:
- More rapid weight gain than expected in the first trimester
- Larger than expected uterus
- Severe morning sickness
- More fetal movement than with a singleton pregnancy
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your doctor may refer you to a healthcare professional who has experience with multiple pregnancies.
Most multiple pregnancies are discovered during an ultrasound examination. An ultrasound examination is a test that uses sound waves to see how the fetus is developing. An ultrasound can detect more than 95% of multiples by the second trimester of pregnancy.
Other tests that may detect a multiple pregnancy include:
- An abnormal result on certain blood tests done near the 16th week of pregnancy
- Hearing more than one heart beat during a routine examination
Multiple pregnancies have a greater risk for certain complications. If you experience any of these conditions, your doctor will discuss the best treatment plan for you.
Most multiple births are preterm (before the end of 37 weeks of pregnancy). Babies born preterm have a higher risk for many health problems. To delay preterm birth, your doctor may suggest bed rest at home or in a hospital or prescribe certain drugs. If labor threatens to occur before 34 weeks of pregnancy you may be given steroid medication to help your babies’ lungs mature.
Gestational diabetes is a disorder in which the body becomes less sensitive to insulin resulting in high blood sugar levels. Gestational diabetes treatment aims to return blood sugar levels to normal through diet, exercise, blood sugar level testing, and sometimes insulin shots.
Twin Twin Transfusion Syndrome (TTTS)
Twins sometimes share vessels in the placenta. If this sharing is unequal, this syndrome can develop. In TTTS, one twin transfuses (donates blood) to the other. The donor twin becomes anemic and the receiving twin develops problems of having too much blood and fluid in it’s body.
To help reduce your chance of having health problems during a multiple pregnancy, take the following steps:
- Get early and regular prenatal care so your doctor can closely monitor your pregnancy.
- Follow general pregnancy nutrition advice, including getting more calcium, folic acid, protein, and iron in your diet.
- Gain the appropriate amount of weight, especially in the first 20-24 weeks of pregnancy.
American Congress of Obstetricians and Gynecologists
March of Dimes Birth Defects Foundation
The Society of Obstetricians and Gynaecologists of Canada
Having twins. American College of Obstetricians and Gynecologists website. Available at: http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ9MI9O97C&sub_cat=2005 . Accessed August 2, 2005.
Multiple births. National Center for Health Statistics website. Available at: http://www.cdc.gov/nchs/fastats/multiple.htm . Accessed August 2, 2005.
Multiples: twins, triplets, and beyond. March of Dimes Birth Defects Foundation website. Available at: http://www.marchofdimes.com/professionals/681_4545.asp . Accessed August 2, 2005.
Preparing for multiple births. KidsHealth–Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy_newborn/pregnancy/multiple_births.html . Accessed August 2, 2005.
Last reviewed December 2009 by
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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